30
PARTS REQUEST FORM
PARTS REQUEST FORM
Paradigm Health & Wellness, Inc.
EMAIL THIS FORM WITH YOUR RECEIPT OF PURCHASE TO
NAME:
_____________________________________________________________________________________
ADDRESS:
__________________________________________________________________________________
CITY:
________________________
STATE:
_____________
ZIP:
_______________________________________
TELEPHONE:
(Day)
______________________________________________________________________
(Night)
_____________________________________________________________________
SERIAL#:
___________________________________________________________________________________
MODEL#:
___________________________________________________________________________________
PURCHASE DATE:
___________________________________________________________________________
PLACE OF PURCHASE:
_______________________________________________________________________
“YOUR ORDER WILL BE PROCESSED WITHIN 3 BUSINESS DAYS”
This form can also be faxed to #: 626-810-2166
PART #
DESCRIPTION
QTY
Summary of Contents for 475SL
Page 7: ...5 LABEL PLACEMENT ...
Page 8: ...6 OVERVIEW DRAWING ...
Page 11: ...9 HARDWARE PARTS PACK ...
